Enhancing exposure therapy for posttraumatic stress disorder (PTSD): a randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer

• DOI: 10.1038/s41398-022-02066-x
• Publication Date: 2022-07-29T11:57:53Z
• Authors: JoAnn Difede; Barbara O. Rothbaum; Albert A. Rizzo; Katarzyna Wyka; Lisa Spielman; Christopher Reist; Michael J. Roy; Tanja Jovanovic; Seth D. Norrholm; Judith Cukor; Megan Olden; Charles E. Glatt; Francis S. Lee
• Keywords: Depression

Abstract Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which will work for whom. We tested the efficacy of virtual reality exposure (VRE) or prolonged imaginal (PE), augmented with D-cycloserine (DCS) combat-related PTSD. As an exploratory aim, we examined whether brain-derived neurotrophic factor (BDNF) fatty acid amide hydrolase (FAAH) moderated response. Military personnel PTSD ( n = 192) were recruited into multisite double-blind randomized controlled trial receive nine weeks VRE PE, DCS placebo. Primary outcome was improvement in symptom severity. Randomization stratified by comorbid depression (MDD) site. Participants both PE showed similar meaningful clinical difference between groups. A interaction p 0.45) suggested more effective depressed participants (CAPS M 3.51 [95% CI 1.17–5.86], 0.004, ES 0.14) while nondepressed (M −8.87 −11.33 −6.40], < 0.001, −0.44). The main effect vs. placebo not significant. Augmentation MDD 0.073) that improved on −8.43 −10.98 −5.88], −0.42); equally participants. There apparent moderating BDNF Val66Met polymorphism augmentation (ES 0.67). Met66 allele carriers −0.25). FAAH 385 than non-carriers 0.33), particularly those 0.62). This study provides step toward precision therapeutics demonstrating genetic markers may help guide selection. ClinicalTrials.gov Identifier: NCT01352637.